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Publisher: Elsevier   (Total: 3043 journals)

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Showing 1 - 200 of 3043 Journals sorted alphabetically
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 20, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 18, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 83, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 23, SJR: 0.612, h-index: 27)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 27, SJR: 2.515, h-index: 90)
Achievements in the Life Sciences     Open Access   (Followers: 4)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 5, SJR: 0.338, h-index: 19)
Acta Astronautica     Hybrid Journal   (Followers: 332, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 3)
Acta Biomaterialia     Hybrid Journal   (Followers: 25, SJR: 2.02, h-index: 104)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 1)
Acta de Investigación Psicológica     Open Access   (Followers: 2)
Acta Ecologica Sinica     Open Access   (Followers: 8, SJR: 0.172, h-index: 29)
Acta Haematologica Polonica     Free   (SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
Acta Materialia     Hybrid Journal   (Followers: 211, SJR: 3.683, h-index: 202)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.615, h-index: 21)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.442, h-index: 21)
Acta Oecologica     Hybrid Journal   (Followers: 9, SJR: 0.915, h-index: 53)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription   (Followers: 1)
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 3, SJR: 0.311, h-index: 16)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 2)
Acta Poética     Open Access   (Followers: 4)
Acta Psychologica     Hybrid Journal   (Followers: 23, SJR: 1.365, h-index: 73)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.059, h-index: 77)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 4)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 3)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 4, SJR: 0.383, h-index: 19)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 2)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 5, SJR: 0.141, h-index: 3)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 4, SJR: 0.112, h-index: 2)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 3)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.967, h-index: 57)
Addictive Behaviors     Hybrid Journal   (Followers: 15, SJR: 1.514, h-index: 92)
Addictive Behaviors Reports     Open Access   (Followers: 5)
Additive Manufacturing     Hybrid Journal   (Followers: 8, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 20)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 129, SJR: 5.2, h-index: 222)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 11, SJR: 1.265, h-index: 53)
Advanced Powder Technology     Hybrid Journal   (Followers: 16, SJR: 0.739, h-index: 33)
Advances in Accounting     Hybrid Journal   (Followers: 9, SJR: 0.299, h-index: 15)
Advances in Agronomy     Full-text available via subscription   (Followers: 15, SJR: 2.071, h-index: 82)
Advances in Anesthesia     Full-text available via subscription   (Followers: 25, SJR: 0.169, h-index: 4)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 3)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 6, SJR: 1.054, h-index: 35)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 10, SJR: 0.801, h-index: 26)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 22, SJR: 1.286, h-index: 49)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 16, SJR: 3.31, h-index: 42)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.277, h-index: 43)
Advances in Botanical Research     Full-text available via subscription   (Followers: 3, SJR: 0.619, h-index: 48)
Advances in Cancer Research     Full-text available via subscription   (Followers: 25, SJR: 2.215, h-index: 78)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 0.9, h-index: 30)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 2.139, h-index: 42)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 12)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 24, SJR: 0.183, h-index: 23)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.665, h-index: 29)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 10, SJR: 1.268, h-index: 45)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 28, SJR: 0.938, h-index: 33)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 18, SJR: 2.314, h-index: 130)
Advances in Computers     Full-text available via subscription   (Followers: 16, SJR: 0.223, h-index: 22)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 11)
Advances in Digestive Medicine     Open Access   (Followers: 4)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 5)
Advances in Drug Research     Full-text available via subscription   (Followers: 22)
Advances in Ecological Research     Full-text available via subscription   (Followers: 41, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 25, SJR: 0.486, h-index: 10)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 7)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 40, SJR: 5.465, h-index: 64)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 3)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 8)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 47, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 15)
Advances in Genetics     Full-text available via subscription   (Followers: 15, SJR: 2.558, h-index: 54)
Advances in Genome Biology     Full-text available via subscription   (Followers: 11)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 2.325, h-index: 20)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 21, SJR: 0.906, h-index: 24)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.497, h-index: 31)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 25)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 2, SJR: 0.396, h-index: 27)
Advances in Immunology     Full-text available via subscription   (Followers: 35, SJR: 4.152, h-index: 85)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 1.132, h-index: 42)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 3, SJR: 1.274, h-index: 27)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 5)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 4)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.764, h-index: 15)
Advances in Lipobiology     Full-text available via subscription   (Followers: 2)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 9)
Advances in Marine Biology     Full-text available via subscription   (Followers: 16, SJR: 1.645, h-index: 45)
Advances in Mathematics     Full-text available via subscription   (Followers: 10, SJR: 3.261, h-index: 65)
Advances in Medical Sciences     Hybrid Journal   (Followers: 6, SJR: 0.489, h-index: 25)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.44, h-index: 51)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 22)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 10)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.324, h-index: 8)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 4)
Advances in Oncobiology     Full-text available via subscription   (Followers: 3)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 15, SJR: 2.885, h-index: 45)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.148, h-index: 11)
Advances in Parasitology     Full-text available via subscription   (Followers: 7, SJR: 2.37, h-index: 73)
Advances in Pediatrics     Full-text available via subscription   (Followers: 24, SJR: 0.4, h-index: 28)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 13)
Advances in Pharmacology     Full-text available via subscription   (Followers: 15, SJR: 1.718, h-index: 58)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 7, SJR: 0.384, h-index: 26)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.248, h-index: 11)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 8)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 4)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 18)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 19, SJR: 1.5, h-index: 62)
Advances in Psychology     Full-text available via subscription   (Followers: 60)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 5, SJR: 0.478, h-index: 32)
Advances in Radiation Oncology     Open Access  
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 2, SJR: 0.1, h-index: 2)
Advances in Space Research     Full-text available via subscription   (Followers: 345, SJR: 0.606, h-index: 65)
Advances in Structural Biology     Full-text available via subscription   (Followers: 8)
Advances in Surgery     Full-text available via subscription   (Followers: 7, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 30, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 15)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 43, SJR: 2.408, h-index: 94)
Aeolian Research     Hybrid Journal   (Followers: 5, SJR: 0.973, h-index: 22)
Aerospace Science and Technology     Hybrid Journal   (Followers: 309, SJR: 0.816, h-index: 49)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.318, h-index: 36)
African J. of Emergency Medicine     Open Access   (Followers: 5, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 8, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 405, SJR: 1.385, h-index: 72)
Agri Gene     Hybrid Journal  
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 15, SJR: 2.18, h-index: 116)
Agricultural Systems     Hybrid Journal   (Followers: 30, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 38, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access  
Agriculture and Natural Resources     Open Access   (Followers: 1)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 53, SJR: 1.879, h-index: 120)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.434, h-index: 14)
Air Medical J.     Hybrid Journal   (Followers: 5, SJR: 0.234, h-index: 18)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.285, h-index: 3)
Alcohol     Hybrid Journal   (Followers: 9, SJR: 0.922, h-index: 66)
Alcoholism and Drug Addiction     Open Access   (Followers: 6)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.436, h-index: 12)
Alexandria J. of Medicine     Open Access  
Algal Research     Partially Free   (Followers: 8, SJR: 2.05, h-index: 20)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 3)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.46, h-index: 29)
Allergology Intl.     Open Access   (Followers: 4, SJR: 0.776, h-index: 35)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 7, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 48, SJR: 4.289, h-index: 64)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 5)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 3)
American Heart J.     Hybrid Journal   (Followers: 48, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 45, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 38, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 6, SJR: 1.091, h-index: 45)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 16, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 31, SJR: 8.769, h-index: 256)
American J. of Infection Control     Hybrid Journal   (Followers: 24, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 33, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 46, SJR: 2.023, h-index: 189)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 191, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 54, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 3)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.249, h-index: 88)
American J. of Otolaryngology     Hybrid Journal   (Followers: 23, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 26, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 21, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 34, SJR: 1.286, h-index: 125)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.653, h-index: 70)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 5)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.066, h-index: 51)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 55, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 10)
Anales de Cirugia Vascular     Full-text available via subscription  
Anales de Pediatría     Full-text available via subscription   (Followers: 2, SJR: 0.209, h-index: 27)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription   (SJR: 0.104, h-index: 3)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 2, SJR: 2.577, h-index: 7)
Analytica Chimica Acta     Hybrid Journal   (Followers: 38, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 162, SJR: 0.725, h-index: 154)
Analytical Chemistry Research     Open Access   (Followers: 8, SJR: 0.18, h-index: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 11)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 1)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 22, SJR: 0.421, h-index: 40)
Angiología     Full-text available via subscription   (SJR: 0.124, h-index: 9)
Angiologia e Cirurgia Vascular     Open Access  
Animal Behaviour     Hybrid Journal   (Followers: 158, SJR: 1.907, h-index: 126)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 5, SJR: 1.151, h-index: 83)
Animal Reproduction Science     Hybrid Journal   (Followers: 5, SJR: 0.711, h-index: 78)
Annales d'Endocrinologie     Full-text available via subscription   (Followers: 1, SJR: 0.394, h-index: 30)
Annales d'Urologie     Full-text available via subscription  
Annales de Cardiologie et d'Angéiologie     Full-text available via subscription   (SJR: 0.177, h-index: 13)
Annales de Chirurgie de la Main et du Membre Supérieur     Full-text available via subscription  
Annales de Chirurgie Plastique Esthétique     Full-text available via subscription   (Followers: 2, SJR: 0.354, h-index: 22)
Annales de Chirurgie Vasculaire     Full-text available via subscription   (Followers: 1)

        1 2 3 4 5 6 7 8 | Last   [Sort by number of followers]   [Restore default list]

Journal Cover American Journal of Medicine
  [SJR: 2.023]   [H-I: 189]   [46 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0002-9343 - ISSN (Online) 1555-7162
   Published by Elsevier Homepage  [3043 journals]
  • Celiac Disease and Increased Risk of Pneumococcal Infection: a Systematic
           Review and Meta-Analysis
    • Authors: Malorie Simons; Lori A. Scott-Sheldon; Yesenia Risech-Neyman; Steven F. Moss; Jonas F. Ludvigsson; Peter H.R. Green
      Abstract: Publication date: Available online 8 August 2017
      Source:The American Journal of Medicine
      Author(s): Malorie Simons, Lori A.J. Scott-Sheldon, Yesenia Risech-Neyman, Steven Moss, Jonas F Ludvigsson, Peter HR Green
      Background Celiac disease has been associated with hyposplenism and multiple case reports link Celiac disease and pneumococcal infections; however, increased risk of pneumococcal infection in celiac disease has not been confirmed. The purpose of this study was to conduct a systematic review to determine the risk of pneumococcal infections in celiac disease. Methods Relevant studies were identified using electronic bibliographic searches of PubMed, OVID Medline and EMBASE (1980 to February 2017) and reviewing abstracts from major conferences in gastroenterology. Using number of events in celiac patients and referent patients we calculated a summary relative risk of pneumococcal infections. All analyses were conducted in Comprehensive Meta-analysis software using random-effects assumptions. Results Of a total of 156 manuscripts, 3, representing three large databases including the Swedish National Inpatient Register; the Oxford Record Linkage Study; and the English National Hospital Episode Statistics, were included. Each compared patients with celiac disease and confirmed pneumococcal infection to a specific reference group: inpatients and/or the general population. Overall, the odds of pneumococcal infection were higher among hospitalized celiac patients compared to controls (odds ratio= 1.66; CI 95% 1.43, 1.92). There was no evidence of heterogeneity (Q[1] = 1.17, p = .56, I 2 = 0%). Conclusions Celiac disease is associated with an increased risk of pneumococcal infection. Preventive pneumococcal vaccination should be considered for those with celiac disease, with special attention to those ages 15 to 64 who have not received the scheduled pneumococcal vaccination series as a child.

      PubDate: 2017-08-16T13:06:07Z
      DOI: 10.1016/s0016-5085(17)32546-5
      Issue No: Vol. 152, No. 5 (2017)
       
  • An Unusual Presentation of Thrombotic Thrombocytopenic Purpura
    • Authors: Yaolin Zhou; Stephanie D. Reilly; Radhika Gangaraju; Vishnu V.B. Reddy; Marisa B. Marques
      Abstract: Publication date: August 2017
      Source:The American Journal of Medicine, Volume 130, Issue 8
      Author(s): Yaolin Zhou, Stephanie D. Reilly, Radhika Gangaraju, Vishnu V.B. Reddy, Marisa B. Marques


      PubDate: 2017-08-16T13:06:07Z
      DOI: 10.1016/j.amjmed.2017.04.022
       
  • Not Just Skin Deep: Distant Metastases from Cutaneous Squamous Cell
           Carcinoma
    • Authors: Ajay Major; Mel Anderson
      Abstract: Publication date: August 2017
      Source:The American Journal of Medicine, Volume 130, Issue 8
      Author(s): Ajay Major, Mel Anderson


      PubDate: 2017-08-16T13:06:07Z
      DOI: 10.1016/j.amjmed.2017.02.031
       
  • Hemispheric Cerebral Edema
    • Authors: Ina Dubin; Yosef Drahy; Ami Schattner
      Abstract: Publication date: August 2017
      Source:The American Journal of Medicine, Volume 130, Issue 8
      Author(s): Ina Dubin, Yosef Drahy, Ami Schattner


      PubDate: 2017-08-16T13:06:07Z
      DOI: 10.1016/j.amjmed.2017.02.045
       
  • Polypharmacy in Elderly Patients: The March Goes On and On
    • Authors: Joseph S. Alpert
      Pages: 875 - 876
      Abstract: Publication date: August 2017
      Source:The American Journal of Medicine, Volume 130, Issue 8
      Author(s): Joseph S. Alpert


      PubDate: 2017-08-16T13:06:07Z
      DOI: 10.1016/j.amjmed.2017.03.012
       
  • Conquering ‘Neurophobia’
    • Authors: William J. Mullally
      First page: 877
      Abstract: Publication date: August 2017
      Source:The American Journal of Medicine, Volume 130, Issue 8
      Author(s): William J. Mullally


      PubDate: 2017-08-16T13:06:07Z
      DOI: 10.1016/j.amjmed.2017.04.019
       
  • Denying International Medical Graduates Entry to the United States: A Loss
           at Both Ends
    • Authors: Courtney Pisano; Haris Riaz
      Pages: 878 - 879
      Abstract: Publication date: August 2017
      Source:The American Journal of Medicine, Volume 130, Issue 8
      Author(s): Courtney Pisano, Haris Riaz


      PubDate: 2017-08-16T13:06:07Z
      DOI: 10.1016/j.amjmed.2017.03.027
       
  • Concierge Medicine Is Here and Growing!!
    • Authors: James E. Dalen; Joseph S. Alpert
      Pages: 880 - 881
      Abstract: Publication date: August 2017
      Source:The American Journal of Medicine, Volume 130, Issue 8
      Author(s): James E. Dalen, Joseph S. Alpert


      PubDate: 2017-08-16T13:06:07Z
      DOI: 10.1016/j.amjmed.2017.03.031
       
  • Why California's Proposition 61 Was a Bad Idea
    • Authors: Y. Tony Yang; Brian Chen; Charles L. Bennett
      Pages: 882 - 884
      Abstract: Publication date: August 2017
      Source:The American Journal of Medicine, Volume 130, Issue 8
      Author(s): Y. Tony Yang, Brian Chen, Charles L. Bennett


      PubDate: 2017-08-16T13:06:07Z
      DOI: 10.1016/j.amjmed.2017.03.046
       
  • Concussion
    • Authors: William J. Mullally
      Pages: 885 - 892
      Abstract: Publication date: August 2017
      Source:The American Journal of Medicine, Volume 130, Issue 8
      Author(s): William J. Mullally
      Concussion has been recognized as a clinical entity for more than 1000 years. Throughout the 20th century it was studied extensively in boxers, but it did not pique the interest of the general population because it is the accepted goal of the boxer to inflict such an injury on their opponent. In 2002, however, the possibility that repetitive concussions could result in chronic brain damage and a progressive neurologic disorder was raised by a postmortem evaluation of a retired player in the most popular sports institution in the United States, the National Football League. Since that time concussion has been a frequent topic of conversation in homes, schools, and on television and has become a major focus of sports programs in communities and schools at all levels. Now all 50 states, the District of Columbia, and the National Collegiate Athletic Association have enacted laws and rules to protect the athlete.

      PubDate: 2017-08-16T13:06:07Z
      DOI: 10.1016/j.amjmed.2017.04.016
       
  • Is Salt a Culprit or an Innocent Bystander in Hypertension' A
           Hypothesis Challenging the Ancient Paradigm
    • Authors: James J. DiNicolantonio; Varshil Mehta; James H. O'Keefe
      Pages: 893 - 899
      Abstract: Publication date: August 2017
      Source:The American Journal of Medicine, Volume 130, Issue 8
      Author(s): James J. DiNicolantonio, Varshil Mehta, James H. O'Keefe
      For decades the notion that an excessive consumption of salt (NaCl) leads to hypertension has persisted. However, this idea is based on opinion, not scientific proof. Despite this, every health organization, agency, and clinicians around the world have been advising salt restriction, especially to hypertensive patients. The present review article suggests that the consumption of a high-salt diet is not the cause of hypertension and that there are other factors, such as added sugars, which are causative for inducing hypertension and cardiovascular disease.

      PubDate: 2017-08-16T13:06:07Z
      DOI: 10.1016/j.amjmed.2017.03.011
       
  • Edoxaban: How Does the Newest Agent Fit into the DOAC Landscape'
    • Authors: Caitlin M. Gibson; Shannon W. Finks
      Pages: 900 - 906
      Abstract: Publication date: August 2017
      Source:The American Journal of Medicine, Volume 130, Issue 8
      Author(s): Caitlin M. Gibson, Shannon W. Finks
      Edoxaban is the most recently approved factor Xa inhibitor within the class of direct oral anticoagulants (DOACs). Like other DOACs, edoxaban was approved by the US Food and Drug Administration for treatment of venous thromboembolism and prevention of stroke in patients with nonvalvular atrial fibrillation. Similar to other DOACs, edoxaban has fewer drug–drug interactions than warfarin and does not require routine laboratory monitoring. Unlike other DOACs, edoxaban has yet to be approved for secondary or postoperative venous thromboembolism thromboprophylaxis. Currently no antidote for edoxaban is available. To optimally prescribe agents in the DOAC class, it is critical that providers 1) understand how the agents compare; and 2) identify specific settings in which one agent may be preferred over another.

      PubDate: 2017-08-16T13:06:07Z
      DOI: 10.1016/j.amjmed.2017.02.048
       
  • Coronary Artery Bypass Surgery and Percutaneous Coronary Intervention in
           Patients with Diabetes
    • Authors: Wilbert S. Aronow; Tatyana A. Shamliyan
      Pages: 907 - 914.e1
      Abstract: Publication date: August 2017
      Source:The American Journal of Medicine, Volume 130, Issue 8
      Author(s): Wilbert S. Aronow, Tatyana A. Shamliyan


      PubDate: 2017-08-16T13:06:07Z
      DOI: 10.1016/j.amjmed.2017.03.034
       
  • Complete Blood Count or Complete Blood Count with Differential: What's the
           Difference'
    • Authors: Deepak Agrawal; Ravi Sarode
      Pages: 915 - 916
      Abstract: Publication date: August 2017
      Source:The American Journal of Medicine, Volume 130, Issue 8
      Author(s): Deepak Agrawal, Ravi Sarode


      PubDate: 2017-08-16T13:06:07Z
      DOI: 10.1016/j.amjmed.2017.03.049
       
  • A Predictive Diagnosis: Organizing Pneumonia
    • Authors: Daniel J. Pearson; Tyson J. Sjulin; Amy A. Zingalis; Andrew J. Skabelund
      Pages: 917 - 921
      Abstract: Publication date: August 2017
      Source:The American Journal of Medicine, Volume 130, Issue 8
      Author(s): Daniel J. Pearson, Tyson J. Sjulin, Amy A. Zingalis, Andrew J. Skabelund


      PubDate: 2017-08-16T13:06:07Z
      DOI: 10.1016/j.amjmed.2017.03.024
       
  • A History Lesson: Pulmonary Vein Stenosis
    • Authors: Erin A. Fender; R. Jay Widmer; Douglas L. Packer; David R. Holmes
      Pages: 922 - 924
      Abstract: Publication date: August 2017
      Source:The American Journal of Medicine, Volume 130, Issue 8
      Author(s): Erin A. Fender, R. Jay Widmer, Douglas L. Packer, David R. Holmes


      PubDate: 2017-08-16T13:06:07Z
      DOI: 10.1016/j.amjmed.2017.05.001
       
  • Breathless: Beta Thalassemia Major
    • Authors: Vassiliki Katsi; Georgios Georgiopoulos; Georgia Vogiatzi; Dimitrios Tousoulis
      Pages: 925 - 926
      Abstract: Publication date: August 2017
      Source:The American Journal of Medicine, Volume 130, Issue 8
      Author(s): Vassiliki Katsi, Georgios Georgiopoulos, Georgia Vogiatzi, Dimitrios Tousoulis


      PubDate: 2017-08-16T13:06:07Z
      DOI: 10.1016/j.amjmed.2017.04.012
       
  • Choosing Wisely' Measuring the Burden of Medications in Older Adults
           near the End of Life: Nationwide, Longitudinal Cohort Study
    • Authors: Lucas Morin; Davide L. Vetrano; Debora Rizzuto; Amaia Calderón-Larrañaga; Johan Fastbom; Kristina Johnell
      Pages: 927 - 936.e9
      Abstract: Publication date: August 2017
      Source:The American Journal of Medicine, Volume 130, Issue 8
      Author(s): Lucas Morin, Davide L. Vetrano, Debora Rizzuto, Amaia Calderón-Larrañaga, Johan Fastbom, Kristina Johnell
      Background The burden of medications near the end of life has recently come under scrutiny, because several studies suggested that people with life-limiting illness receive potentially futile treatments. Methods We identified 511,843 older adults (>65 years) who died in Sweden between 2007 and 2013 and reconstructed their drug prescription history for each of the last 12 months of life through the Swedish Prescribed Drug Register. Decedents' characteristics at time of death were assessed through record linkage with the National Patient Register, the Social Services Register, and the Swedish Education Register. Results Over the course of the final year before death, the proportion of individuals exposed to ≥10 different drugs rose from 30.3% to 47.2% (P <.001 for trend). Although older adults who died from cancer had the largest increase in the number of drugs (mean difference, 3.37; 95% confidence interval, 3.35 to 3.40), living in an institution was independently associated with a slower escalation (β = −0.90, 95% confidence interval, −0.92 to −0.87). During the final month before death, analgesics (60.8%), anti-throm-botic agents (53.8%), diuretics (53.1%), psycholeptics (51.2%), and β-blocking agents (41.1%) were the 5 most commonly used drug classes. Angiotensin-converting enzyme inhibitors and statins were used by, respectively, 21.4% and 15.8% of all individuals during their final month of life. Conclusion Polypharmacy increases throughout the last year of life of older adults, fueled not only by symptomatic medications but also by long-term preventive treatments of questionable benefit. Clinical guidelines are needed to support physicians in their decision to continue or discontinue medications near the end of life.

      PubDate: 2017-08-16T13:06:07Z
      DOI: 10.1016/j.amjmed.2017.02.028
       
  • Osteoporosis in the Women's Health Initiative: Another Treatment Gap'
    • Authors: Maryam Sattari; Jane A. Cauley; Cynthia Garvan; Karen C. Johnson; Michael J. LaMonte; Wenjun Li; Marian Limacher; Todd Manini; Gloria E. Sarto; Shannon D. Sullivan; Jean Wactawski-Wende; Rebecca J. Beyth
      Pages: 937 - 948
      Abstract: Publication date: August 2017
      Source:The American Journal of Medicine, Volume 130, Issue 8
      Author(s): Maryam Sattari, Jane A. Cauley, Cynthia Garvan, Karen C. Johnson, Michael J. LaMonte, Wenjun Li, Marian Limacher, Todd Manini, Gloria E. Sarto, Shannon D. Sullivan, Jean Wactawski-Wende, Rebecca J. Beyth
      Background Osteoporotic fractures are associated with high morbidity, mortality, and cost. Methods We performed a post hoc analysis of the Women's Health Initiative (WHI) clinical trials data to assess osteoporosis treatment and identify participant characteristics associated with utilization of osteoporosis medication(s) after new diagnoses of osteoporosis or fracture. Information from visits prior to and immediately subsequent to the first fracture event or osteoporosis diagnosis were evaluated for medication use. A full logistic regression model was used to identify factors predictive of osteoporosis medication use after a fracture or a diagnosis of osteoporosis. Results The median length of follow-up from enrollment to the last WHI clinic visit for the study cohort was 13.9 years. Among the 13,990 women who reported new diagnoses of osteoporosis or fracture between enrollment and their final WHI visit, and also had medication data available, 21.6% reported taking an osteoporosis medication other than estrogen. Higher daily calcium intake, diagnosis of osteoporosis alone or both osteoporosis and fracture (compared with diagnosis of fracture alone), Asian or Pacific Islander race/ethnicity (compared with White/Caucasian), higher income, and hormone therapy use (past or present) were associated with significantly higher likelihood of osteoporosis pharmacotherapy. Women with Black/African American race/ethnicity (compared with White/Caucasian), body mass index ≥30 (compared with body mass index of 18.5-24.9), current tobacco use (compared with past use or lifetime nonusers), and history of arthritis were less likely to use osteoporosis treatment. Conclusion Despite well-established treatment guidelines in postmenopausal women with osteoporosis or history of fractures, pharmacotherapy use was suboptimal in this study. Initiation of osteoporosis treatment after fragility fracture may represent an opportunity to improve later outcomes in these high-risk women. Specific attention needs to be paid to increasing treatment among women with fragility fractures, obesity, current tobacco use, history of arthritis, or of Black race/ethnicity.

      PubDate: 2017-08-16T13:06:07Z
      DOI: 10.1016/j.amjmed.2017.02.042
       
  • Interaction of Physical Activity and Body Mass Index on Mortality in
           Coronary Heart Disease: Data from the Nord-Trøndelag Health Study
    • Authors: Trine Moholdt; Carl J. Lavie; Javaid Nauman
      Pages: 949 - 957
      Abstract: Publication date: August 2017
      Source:The American Journal of Medicine, Volume 130, Issue 8
      Author(s): Trine Moholdt, Carl J. Lavie, Javaid Nauman
      Objective The role of physical activity in the relationship between body mass index (BMI) and survival in coronary heart disease is unclear. Our aim was to examine the isolated and combined associations among BMI, physical activity, and mortality in subjects with coronary heart disease. Methods A total of 6493 participants (34.4% were women) with coronary heart disease from the Nord-Trøndelag Health Study, with examinations in 1986, 1996, and 2007, were followed to the end of 2014. We calculated hazard ratios (HRs) for all-cause and cardiovascular disease mortality, estimated using Cox proportionate hazard regression adjusted for age, smoking, diabetes, hypertension, self-reported health status, and alcohol. Results A total of 3818 patients died (62.1% of cardiovascular disease) during 30 (median 12.5) years of follow-up. Compared with a BMI of 18.5 to 22.4 kg/m2, BMI categories of 25.0 to 27.4 kg/m2, 27.5 to 29.9 kg/m2, and 30.0 to 34.9 kg/m2 had reduced all-cause mortality risk: HR, 0.80; 95% confidence interval (CI), 0.72-0.90; HR, 0.80; 95% CI, 0.71-0.90; HR, 0.83; 95% CI, 0.74-0.95, respectively. The BMI categories 25.0 to 27.4 kg/m2 and 27.5 to 29.9 kg/m2 had reduced cardiovascular disease mortality risk: HR, 0.81; 95% CI, 0.70-0.94; HR, 0.83; 95% CI, 0.71-0.96, respectively. Compared with physically inactive, all levels of physical activity were associated with reduced all-cause and cardiovascular disease mortality risk. In physically inactive, all BMI categories >25.0 kg/m2 had reduced all-cause mortality risk (HRs across BMI categories: 0.77, 0.79, 0.79, 0.74), whereas in subjects who were following or exceeding the recommended level of physical activity, BMI was not associated with survival. Conclusions Overweight and obese subjects with coronary heart disease had reduced all-cause and cardiovascular disease mortality, but such an obesity paradox was seen only in participants who did not adhere to current recommendations of physical activity.

      PubDate: 2017-08-16T13:06:07Z
      DOI: 10.1016/j.amjmed.2017.01.043
       
  • Upper Body Subcutaneous Fat Is Associated with Cardiometabolic Risk
           Factors
    • Authors: Jane J. Lee; Alison Pedley; Kate E. Therkelsen; Udo Hoffmann; Joseph M. Massaro; Daniel Levy; Michelle T. Long
      Pages: 958 - 966.e1
      Abstract: Publication date: August 2017
      Source:The American Journal of Medicine, Volume 130, Issue 8
      Author(s): Jane J. Lee, Alison Pedley, Kate E. Therkelsen, Udo Hoffmann, Joseph M. Massaro, Daniel Levy, Michelle T. Long
      Background Upper body subcutaneous fat is a distinct fat depot that may confer increased cardiometabolic risk. We examined the cross-sectional associations between upper body subcutaneous fat volume and cardiometabolic risk factors. Methods Participants were patients from the Framingham Heart Study who underwent multi-detector computed tomography between 2008 and 2011. Sex-specific multivariable-adjusted regression analyses were conducted. Covariates included age, ethnicity, smoking status, alcohol intake, physical activity, postmenopausal status, and hormone replacement therapy. Additional models included adjustment for body mass index (BMI), neck circumference, or abdominal visceral adipose tissue. Results There were 2306 participants (mean age 60 years, 54.4% women) included. Mean upper body subcutaneous fat was 309.9 cm3 in women and 345.6 cm3 in men. Higher upper body subcutaneous fat volume was associated with adverse cardiometabolic risk factors. In women and men, each additional 50-cm3 increment in upper body subcutaneous fat was associated with a 3.23 and 2.65 kg/m2 increase in BMI; 2.16 and 0.88 mm Hg increase in systolic blood pressure; 2.53 and 1.66 mg/dL increase in fasting plasma glucose; 0.12 and 0.11 mg/dL increase in log triglycerides; and 4.17 and 3.68 mg/dL decrease in high-density lipoprotein cholesterol, respectively (all P ≤.008). Similar patterns were observed with prevalent cardiometabolic risk factors. These associations remained significant after additional adjustment for BMI, neck circumference, or abdominal visceral adipose tissue. Conclusions Higher upper body subcutaneous fat is cross-sectionally associated with adverse cardiometabolic risk factors. Our findings underscore the importance of subcutaneous adiposity in the upper body region that may provide a better understanding of the pathogenic properties of obesity in the development of cardiometabolic sequelae.

      PubDate: 2017-08-16T13:06:07Z
      DOI: 10.1016/j.amjmed.2017.01.044
       
  • Alcohol Intake More than Doubles the Risk of Early Cardiovascular Events
           in Young Hypertensive Smokers
    • Authors: Paolo Palatini; Claudio Fania; Lucio Mos; Adriano Mazzer; Francesca Saladini; Edoardo Casiglia
      Pages: 967 - 974.e1
      Abstract: Publication date: August 2017
      Source:The American Journal of Medicine, Volume 130, Issue 8
      Author(s): Paolo Palatini, Claudio Fania, Lucio Mos, Adriano Mazzer, Francesca Saladini, Edoardo Casiglia
      Purpose An interactive effect of tobacco and alcohol use has been described for cancer. The aim of this study was to investigate the joint effect of smoking and alcohol intake on major adverse cardiovascular and renal events (MACE) in young subjects screened for stage 1 hypertension. Methods A total of 1204 untreated patients aged from 18 to 45 years (mean 33.1) were included in this prospective cohort study. Subjects were classified into 4 categories of cigarette smoking and 3 classes of alcohol use. Main outcome variable was risk for MACE. Results During a 12.6-year follow-up, there were 74 fatal and nonfatal MACE. In multivariable Cox models, current smoking and alcohol drinking were associated with risk of MACE. In a multivariable model also including follow-up changes in blood pressure and body weight, hazard ratio (HR) was 1.48 (95% confidence interval [CI], 1.20-1.83) for smoking and was 1.82 (95% CI, 1.05-3.15) for alcohol use. In addition, an interactive effect was found between smoking and alcohol on risk of MACE (P <.001). Among the 142 smokers who also drank alcoholic beverages, the risk of MACE (HR 4.02; 95% CI, 1.98-8.15) was more than doubled compared with the 112 smokers who abstained from drinking (HR 1.64; 95% CI, 0.63-4.27). In the group of heavy smokers who also were alcohol drinkers (n = 51), the risk of MACE was even quadrupled (HR 7.79; 95% CI, 4.22-14.37). Conclusion Alcohol use potentiates the deleterious cardiovascular effects of heavy smoking in stage 1 hypertensive subjects younger than 45 years. These results call for prompt intervention addressed to improve unhealthy behaviors in these subjects.

      PubDate: 2017-08-16T13:06:07Z
      DOI: 10.1016/j.amjmed.2017.02.041
       
  • Errors in Diagnosis of Spinal Epidural Abscesses in the Era of Electronic
           Health Records
    • Authors: Viraj Bhise; Ashley N.D. Meyer; Hardeep Singh; Li Wei; Elise Russo; Aymer Al-Mutairi; Daniel R. Murphy
      Pages: 975 - 981
      Abstract: Publication date: August 2017
      Source:The American Journal of Medicine, Volume 130, Issue 8
      Author(s): Viraj Bhise, Ashley N.D. Meyer, Hardeep Singh, Li Wei, Elise Russo, Aymer Al-Mutairi, Daniel R. Murphy
      Purpose With this study, we set out to identify missed opportunities in diagnosis of spinal epidural abscesses to outline areas for process improvement. Methods Using a large national clinical data repository, we identified all patients with a new diagnosis of spinal epidural abscess in the Department of Veterans Affairs (VA) during 2013. Two physicians independently conducted retrospective chart reviews on 250 randomly selected patients and evaluated their records for red flags (eg, unexplained weight loss, neurological deficits, and fever) 90 days prior to diagnosis. Diagnostic errors were defined as missed opportunities to evaluate red flags in a timely or appropriate manner. Reviewers gathered information about process breakdowns related to patient factors, the patient–provider encounter, test performance and interpretation, test follow-up and tracking, and the referral process. Reviewers also determined harm and time lag between red flags and definitive diagnoses. Results Of 250 patients, 119 had a new diagnosis of spinal epidural abscess, 66 (55.5%) of which experienced diagnostic error. Median time to diagnosis in error cases was 12 days, compared with 4 days in cases without error (P <.01). Red flags that were frequently not evaluated in error cases included unexplained fever (n = 57; 86.4%), focal neurological deficits with progressive or disabling symptoms (n = 54; 81.8%), and active infection (n = 54; 81.8%). Most errors involved breakdowns during the patient–provider encounter (n = 60; 90.1%), including failures in information gathering/integration, and were associated with temporary harm (n = 43; 65.2%). Conclusion Despite wide availability of clinical data, errors in diagnosis of spinal epidural abscesses are common and involve inadequate history, physical examination, and test ordering. Solutions should include renewed attention to basic clinical skills.

      PubDate: 2017-08-16T13:06:07Z
      DOI: 10.1016/j.amjmed.2017.03.009
       
  • Patient-Specific Tailored Intervention Improves INR Time in Therapeutic
           Range and INR Variability in Heart Failure Patients
    • Authors: Israel Gotsman; Orly Ezra; Bruria Hirsh Raccah; Dan Admon; Chaim Lotan; Freda Dekeyser Ganz
      Pages: 982 - 989
      Abstract: Publication date: August 2017
      Source:The American Journal of Medicine, Volume 130, Issue 8
      Author(s): Israel Gotsman, Orly Ezra, Bruria Hirsh Raccah, Dan Admon, Chaim Lotan, Freda Dekeyser Ganz
      Background Many patients with heart failure need anticoagulants, including warfarin. Good control is particularly challenging in heart failure patients, with <60% of international normalized ratio (INR) measurements in the therapeutic range, thereby increasing the risk of complications. This study aimed to evaluate the effect of a patient-specific tailored intervention on anticoagulation control in patients with heart failure. Methods Patients with heart failure taking warfarin therapy (n = 145) were randomized to either standard care or a 1-time intervention assessing potential risk factors for lability of INR, in which they received patient-specific instructions. Time in therapeutic range (TTR) using Rosendaal's linear model was assessed 3 months before and after the intervention. Results The patient-tailored intervention significantly increased anticoagulation control. The median TTR levels before intervention were suboptimal in the interventional and control groups (53% vs 45%, P = .14). After intervention the median TTR increased significantly in the interventional group compared with the control group (80% [interquartile range, 62%-93%] vs 44% [29%-61%], P <.0001). The intervention resulted in a significant improvement in the interventional group before versus after intervention (53% vs 80%, P <.0001) but not in the control group (45% vs 44%, P = .95). The percentage of patients with a TTR ≥60%, considered therapeutic, was substantially higher in the interventional group: 79% versus 25% (P <.0001). The INR variability (standard deviation of each patient's INR measurements) decreased significantly in the interventional group, from 0.53 to 0.32 (P <.0001) after intervention but not in the control group. Conclusions Patient-specific tailored intervention significantly improves anticoagulation therapy in patients with heart failure.

      PubDate: 2017-08-16T13:06:07Z
      DOI: 10.1016/j.amjmed.2017.02.030
       
  • Top 10 Lessons Learned from Project Healthy Schools
    • Authors: Ryan Rogers; Rachel Krallman; Elizabeth A. Jackson; Jean DuRussel-Weston; LaVaughn Palma-Davis; Rosa de Visser; Taylor Eagle; Kim A. Eagle; Eva Kline-Rogers
      Pages: 990.e1 - 990.e7
      Abstract: Publication date: August 2017
      Source:The American Journal of Medicine, Volume 130, Issue 8
      Author(s): Ryan Rogers, Rachel Krallman, Elizabeth A. Jackson, Jean DuRussel-Weston, LaVaughn Palma-Davis, Rosa de Visser, Taylor Eagle, Kim A. Eagle, Eva Kline-Rogers
      Childhood obesity is increasing in the United States; obese children are more likely to become obese adults with obesity-associated health issues. Effective programs designed to reduce the prevalence of childhood overweight and obesity are needed. We sought to review one such program, Project Healthy Schools (PHS), for key findings. Project Healthy Schools is a health curriculum that includes educational lessons, school environment changes, and health measurement. Data have shown improvement in numerous metrics after the program, including positive changes in physiologic measures and healthier lifestyle behaviors. The school's socioeconomic status has been shown to correlate with baseline and follow-up measures, and gender differences exist. Additionally, school environmental changes support improved health behaviors. The collaborative effort and support of various stakeholders have led to the success of this health education program, resulting in numerous physiologic and behavioral benefits in middle school students throughout Michigan, and providing a replicable, real-world approach to combating childhood obesity.

      PubDate: 2017-08-16T13:06:07Z
      DOI: 10.1016/j.amjmed.2017.03.018
       
  • Iron Supplementation, Response in Iron-Deficiency Anemia: Analysis of Five
           Trials
    • Authors: Maureen M. Okam; Todd A. Koch; Minh-Ha Tran
      Pages: 991.e1 - 991.e8
      Abstract: Publication date: August 2017
      Source:The American Journal of Medicine, Volume 130, Issue 8
      Author(s): Maureen M. Okam, Todd A. Koch, Minh-Ha Tran
      Background Oral iron-replacement therapy is the mainstay of treatment for iron-deficiency anemia, but it is often poorly tolerated or ineffective. Hemoglobin response at day 14 of oral iron may be useful in assessing whether and when to transition patients from oral to intravenous (IV) iron. Methods Pooled data from 5 randomized trials were analyzed to compare oral and IV iron-replacement therapy for iron-deficiency anemia. Treatment criteria and assignment to oral versus IV iron were defined per protocol; this analysis included only subjects receiving oral iron. Responders were subjects with ≥1.0-g/dL increases in hemoglobin at day 14, and nonresponders were those with smaller increases. Demographic and clinical characteristics were evaluated for association with hemoglobin response at multiple timepoints. Results Most subjects (72.8%) were classified as responders. The proportion of subjects with hemoglobin increases ≥1.0, ≥2.0, and ≥3.0 g/dL was greatest among those with postpartum anemia, intermediate among those with heavy uterine bleeding or gastrointestinal-related causes of anemia, and lowest among those with other causes; this proportion was also significantly greater among responders than nonresponders. A ≥1.0-g/dL increase in hemoglobin on day 14 most accurately predicted satisfactory overall hemoglobin response to oral iron on day 42/56 (sensitivity 90.1%; specificity 79.3%; positive and negative predictive values of 92.9% and 72.7%, respectively). Iron-replacement therapy improved quality of life and reduced fatigue. Conclusion Hemoglobin responses <1.0 g/dL at day 14 of oral iron identify subjects with iron-deficiency anemia who should be transitioned to IV iron supplementation.

      PubDate: 2017-08-16T13:06:07Z
      DOI: 10.1016/j.amjmed.2017.03.045
       
  • Quality of Life, Dyspnea, and Functional Exercise Capacity Following a
           First Episode of Pulmonary Embolism: Results of the ELOPE Cohort Study
    • Authors: Susan R. Kahn; Arash Akaberi; John T. Granton; David R. Anderson; Philip S. Wells; Marc A. Rodger; Susan Solymoss; Michael J. Kovacs; Lawrence Rudski; Avi Shimony; Carole Dennie; Chris Rush; Paul Hernandez; Shawn D. Aaron; Andrew M. Hirsch
      Pages: 990.e9 - 990.e21
      Abstract: Publication date: August 2017
      Source:The American Journal of Medicine, Volume 130, Issue 8
      Author(s): Susan R. Kahn, Arash Akaberi, John T. Granton, David R. Anderson, Philip S. Wells, Marc A. Rodger, Susan Solymoss, Michael J. Kovacs, Lawrence Rudski, Avi Shimony, Carole Dennie, Chris Rush, Paul Hernandez, Shawn D. Aaron, Andrew M. Hirsch
      Background We aimed to evaluate health-related quality of life (QOL), dyspnea, and functional exercise capacity during the year following the diagnosis of a first episode of pulmonary embolism. Methods This was a prospective multicenter cohort study of 100 patients with acute pulmonary embolism recruited at 5 Canadian hospitals from 2010-2013. We measured the outcomes QOL (by Short-Form Health Survey-36 [SF-36] and Pulmonary Embolism Quality of Life [PEmb-QoL] measures), dyspnea (by the University of California San Diego Shortness of Breath Questionnaire [SOBQ]) and 6-minute walk distance at baseline and 1, 3, 6, and 12 months after acute pulmonary embolism. Computed tomography pulmonary angiography was performed at baseline, echocardiogram was performed within 10 days, and cardiopulmonary exercise testing was performed at 1 and 12 months. Predictors of change in QOL, dyspnea, and 6-minute walk distance were assessed by repeated-measures mixed-effects models analysis. Results Mean age was 50.0 years; 57% were male and 80% were treated as outpatients. Mean scores for all outcomes improved during 1-year follow-up: from baseline to 12 months, mean SF-36 physical component score improved by 8.8 points, SF-36 mental component score by 5.3 points, PEmb-QoL by −32.1 points, and SOBQ by −16.3 points, and 6-minute walk distance improved by 40 m. Independent predictors of reduced improvement over time were female sex, higher body mass index, and percent-predicted VO2 peak <80% on 1 month cardiopulmonary exercise test for all outcomes; prior lung disease and higher pulmonary artery systolic pressure on 10-day echocardiogram for the outcomes SF-36 physical component score and dyspnea score; and higher main pulmonary artery diameter on baseline computed tomography pulmonary angiography for the outcome PEmb-QoL score. Conclusions On average, QOL, dyspnea, and walking distance improve during the year after pulmonary embolism. However, a number of clinical and physiological predictors of reduced improvement over time were identified, most notably female sex, higher body mass index, and exercise limitation on 1-month cardiopulmonary exercise test. Our results provide new information on patient-relevant prognosis after pulmonary embolism.

      PubDate: 2017-08-16T13:06:07Z
      DOI: 10.1016/j.amjmed.2017.03.033
       
  • The HOMR-Now! Model Accurately Predicts 1-Year Death Risk for Hospitalized
           Patients on Admission
    • Authors: Carl van Walraven; Alan J. Forster
      Pages: 991.e9 - 991.e16
      Abstract: Publication date: August 2017
      Source:The American Journal of Medicine, Volume 130, Issue 8
      Author(s): Carl van Walraven, Alan J. Forster
      Background The Hospital-patient One-year Mortality Risk (HOMR) score is an externally validated index using health administrative data to accurately predict the risk of death within 1 year of admission to the hospital. This study derived and internally validated a HOMR modification using data that are available when the patient is admitted to the hospital. Methods From all adult hospitalizations at our tertiary-care teaching hospital between 2004 and 2015, we randomly selected one per patient. We added to all HOMR variables that could be determined from our hospital's data systems on admission other factors that might prognosticate. Vital statistics registries determined vital status at 1 year from admission. Results Of 2,06,396 patients, 32,112 (15.6%) died within 1 year of admission to the hospital. The HOMR-now! model included patient (sex, comorbidities, living and cancer clinic status, and 1-year death risk from population-based life tables) and hospitalization factors (admission year, urgency, service and laboratory-based acuity score). The model explained that more than half of the total variability (Regenkirke's R 2 value of 0.53) was very discriminative (C-statistic 0.92), and accurately predicted death risk (calibration slope 0.98). Conclusion One-year risk of death can be accurately predicted using routinely collected data available when patients are admitted to the hospital.

      PubDate: 2017-08-16T13:06:07Z
      DOI: 10.1016/j.amjmed.2017.03.008
       
  • Gunshot to the Head
    • Authors: Sheharyar Raza; Donald A. Redelmeier
      Abstract: Publication date: Available online 12 August 2017
      Source:The American Journal of Medicine
      Author(s): Sheharyar Raza, Donald A. Redelmeier


      PubDate: 2017-08-16T13:06:07Z
      DOI: 10.1016/j.amjmed.2017.07.026
       
  • Opioid Drug Use and Acute Cardiac Events among Pregnant Women in the
           United States.
    • Authors: Hamisu M. Salihu; Jason L. Salemi; Anjali Aggarwal; Beverly F. Steele; Ross C. Pepper; Mulubrhan F. Mogos; Muktar H. Aliyu
      Abstract: Publication date: Available online 12 August 2017
      Source:The American Journal of Medicine
      Author(s): Hamisu M. Salihu, Jason L. Salemi, Anjali Aggarwal, Beverly F. Steele, Ross C. Pepper, Mulubrhan F. Mogos, Muktar H. Aliyu
      Background Cardiovascular disease remains a leading cause of pregnancy-associated deaths in the United States (US). The extent to which increasing opioid use among pregnant women contributes to fatal cardiovascular events is unknown. We examine trends in opioid use among pregnant women over the previous decade, and the association between changes in temporal trends in opioid drug use and the incidence of acute cardiac events among mothers. Methods In this retrospective analysis of the Healthcare and Cost Utilization Project (HCUP), we utilized a two-stage stratified cluster sampling of all inpatient hospital discharges from non-federal hospitals between 01/01/2002 through 12/31/2014. The study population comprised pregnant women aged 13–49 years and related hospitalizations, including delivery. The primary exposure of interest was opioid use during pregnancy. The primary outcome was the occurrence of acute myocardial infarction or cardiac arrest during pregnancy or childbirth. Results Among the estimated 57.4 million pregnancy-related inpatient hospitalizations, 511,469 (approximately 1%) had documented use of opioids, cocaine, and/or amphetamines. There was a 300% increase in the use of opioids during pregnancy over the study period, while cocaine consumption significantly decreased and that of amphetamine remained stable. Over the 13-year period, the rise in opioid use paralleled a 50% increase in the incidence of acute cardiac events among mothers. Conclusion Over the previous decade, opioid use during pregnancy increased significantly, in parallel with the rise in the incidence of acute cardiac events in pregnancy and childbirth. An effective national policy is needed to address this emerging public health challenge.

      PubDate: 2017-08-16T13:06:07Z
      DOI: 10.1016/j.amjmed.2017.07.023
       
  • Inferior Vena Cava Filters in Stable Patients with Acute Pulmonary
           Embolism Who Receive Thrombolytic Therapy
    • Authors: Paul D. Stein; Fadi Matta; Mary J. Hughes
      Abstract: Publication date: Available online 12 August 2017
      Source:The American Journal of Medicine
      Author(s): Paul D. Stein, Fadi Matta, Mary J. Hughes
      Background There is a need for further analyses of subgroups of patients with pulmonary embolism who might benefit from vena cava filters. In the present investigation, we analyze mortality with vena cava filters in the subgroup of stable patients with pulmonary embolism who received thrombolytic therapy. We use a different database than used previously, and we analyze data in more recent years. Methods Administrative data were analyzed from the Premier Healthcare Database, 2010-2014, in hospitalized stable patients with pulmonary embolism who received thrombolytic therapy, and may or may not have received a vena cava filter. Patients were identified on the basis of International Classification of Disease-9th Clinical Modification (ICD-9-CM) codes. Results In hospital all-cause mortality in stable patients who received a vena cava filter in addition to thrombolytic therapy was 139 of 2669 (5.2%) compared with 697 of 4332 (16.1%) who did not receive a filter (P<0.0001)(relative risk .32). Mortality was lower with a filter every decade of age > 31 years. Conclusion Among stable patients with acute pulmonary embolism who receive thrombolytic therapy, irrespective of the reason, the additional use of an inferior vena cava filter results in a lower in-hospital mortality.

      PubDate: 2017-08-16T13:06:07Z
      DOI: 10.1016/j.amjmed.2017.07.028
       
  • Cerebellar Hemangioblastoma
    • Authors: Ami Schattner; Emanuella Cagnano; Ina Dubin
      Abstract: Publication date: Available online 12 August 2017
      Source:The American Journal of Medicine
      Author(s): Ami Schattner, Emanuella Cagnano, Ina Dubin


      PubDate: 2017-08-16T13:06:07Z
      DOI: 10.1016/j.amjmed.2017.07.027
       
  • Delayed Diagnosis of Cast Nephropathy
    • Authors: Chihiro Kamijo; Yukinori Harada
      Abstract: Publication date: Available online 12 August 2017
      Source:The American Journal of Medicine
      Author(s): Chihiro Kamijo, Yukinori Harada


      PubDate: 2017-08-16T13:06:07Z
      DOI: 10.1016/j.amjmed.2017.07.031
       
  • Systemic IgG4-Related Disease in an Asymptomatic Patient.
    • Authors: Fernando A. Camporro; Exequiel Bulacio; Ignacio Gutierrez Magaldi
      Abstract: Publication date: Available online 12 August 2017
      Source:The American Journal of Medicine
      Author(s): Fernando A. Camporro, Exequiel Bulacio, Ignacio Gutierrez Magaldi


      PubDate: 2017-08-16T13:06:07Z
      DOI: 10.1016/j.amjmed.2017.07.029
       
  • The Great Imitator: Visual Changes in a 37 Year Old Man with HIV
    • Authors: Chloé A. Powell; Alexander R. Carbo
      Abstract: Publication date: Available online 12 August 2017
      Source:The American Journal of Medicine
      Author(s): Chloé A. Powell, Alexander R. Carbo


      PubDate: 2017-08-16T13:06:07Z
      DOI: 10.1016/j.amjmed.2017.06.043
       
  • Cerebral Air Embolism Following Central Venous Catheter Removal
    • Authors: Liane A. Arcinas; Shuangbo Liu; G. Isanne Schacter; Malek Kass
      Abstract: Publication date: Available online 10 August 2017
      Source:The American Journal of Medicine
      Author(s): Liane A. Arcinas, Shuangbo Liu, G. Isanne Schacter, Malek Kass


      PubDate: 2017-08-16T13:06:07Z
      DOI: 10.1016/j.amjmed.2017.07.024
       
  • Clinical Implications of the Limited Relationship of Voltage Criteria for
           Electrocardiogram Left Ventricular Hypertrophy to Cardiovascular Mortality
           
    • Authors: Le Dung Ha; Ayman Elbadawi; Victor F. Froelicher
      Abstract: Publication date: Available online 10 August 2017
      Source:The American Journal of Medicine
      Author(s): Le Dung Ha, Ayman Elbadawi, Victor F. Froelicher
      Background Numerous methods have been proposed for diagnosing left ventricular hypertrophy using the electrocardiogram. They have limited sensitivity for recognizing pathological hypertrophy at least in part due to their inability to distinguish pathological from physiological hypertrophy. Our objective is to compare the major electrocardiogram - left ventricular hypertrophy criteria using cardiovascular mortality as a surrogate for pathological hypertrophy. Methods This study was a retrospective analysis of 16,253 Veterans less than 56 years of age seen at a large Veteran's Affairs Medical Center from 1987 to 1999 and followed a median of 17.8 years for cardiovascular mortality. Receiver Operator Characteristics (ROC) and Cox Hazard survival techniques were applied. Results Of the 16,253 veterans included in our target population, the mean age was 43, 8.6% were female, 33.5% met criteria for electrocardiogram - left ventricular hypertrophy and there were 744 cardiovascular deaths (annual cardiovascular mortality 0.25%). ROC analysis demonstrated that the greatest area under the curve (AUC) for classification of cardiovascular death was obtained using the Romhilt-Estes score (0.63, 95% Confidence Interval (CI) 0.61 – 0.65). Most of the voltage-only criteria had non-diagnostic AUC's with the Cornell being the best at 0.59 (95% CI 0.57 – 0.62). When the components of the Romhilt-Estes score were examined using step-wise Wald analysis, the voltage criteria dropped from the model. The Romhilt-Estes score ≥ 4, the Cornell and the Peguero had the highest association with cardiovascular mortality (adjusted Hazard Ratio (HR) 2.2, 2.0 and 2.1, consecutively). Conclusion The only electrocardiogram leads with voltage criteria that exhibited sufficient classification power for clinical use were aVL (R wave) and V3 (S wave)

      PubDate: 2017-08-16T13:06:07Z
      DOI: 10.1016/j.amjmed.2017.06.041
       
  • An Uncommon Cause of Low Back Pain
    • Authors: Daniel M Golovko; Jeffrey B Knox
      Abstract: Publication date: Available online 10 August 2017
      Source:The American Journal of Medicine
      Author(s): Daniel M Golovko, Jeffrey B Knox


      PubDate: 2017-08-16T13:06:07Z
      DOI: 10.1016/j.amjmed.2017.06.042
       
  • Differences in Associations of Antidepressants and Hospitalization Due to
           Hyponatremia
    • Authors: Shermineh Farmand; Jonatan Lindh; Jan Calissendorff; Jakob Skov; Henrik Falhammar; David Nathanson; Buster Mannheimer
      Abstract: Publication date: Available online 10 August 2017
      Source:The American Journal of Medicine
      Author(s): Shermineh Farmand, Jonatan Lindh, Jan Calissendorff, Jakob Skov, Henrik Falhammar, David Nathanson, Buster Mannheimer
      Background Selective serotonin reuptake inhibitors (SSRIs) and other antidepressants are important as a cause for hyponatremia. However, most studies have focused on the effect on sodium levels regardless of clinical symptoms or been too small to be able to discriminate between the effects of specific antidepressant drugs. The objective of the present study was to investigate the association between different groups of antidepressants and the risk of hospitalisation due to hyponatremia. Methods In this register based case–control study of patients in the general Swedish population we identified 14 359 individuals with a main diagnosis of hyponatremia. For every case, 4 matched controls were included (n=57 382). To investigate the temporal aspects of drug-induced hyponatremia, antidepressant exposure was divided into patients with newly initiated and ongoing treatment. Univariable and multivariable logistic regression was used to analyse the association of antidepressant use and hospitalization. Results For newly initiated antidepressants, adjusted OR (95% CI) for a main diagnosis of hyponatremia, compared to controls, were for: citalopram 5.50 (4.71-6.44); sertraline 4.96 (3.81-6.48) for; venlafaxine 5.28 (3.20-8.83); tricyclic antidepressants (TCA) 1.59 (1.13-2.24); and mirtazapine 2.54 (2.04-3.16). Adjusted OR (CI) for individuals with ongoing treatment ranged from 0.57 (0.52-0.63) for citalopram to 1.08 (0.85-1.36) for other SSRIs. Conclusions There was a strong association between newly initiated treatment with SSRIs or venlafaxine and hospitalization due to hyponatremia. The association for TCA and mirtazapine was small to moderate. In contrast, there was no evidence that ongoing treatment with antidepressants increases the risk for hospitalization due to hyponatremia.

      PubDate: 2017-08-16T13:06:07Z
      DOI: 10.1016/j.amjmed.2017.07.025
       
  • Aspiration Pneumonia in Patients with Carbon Monoxide Poisoning Who Had
           Loss of Consciousness: Prevalence, Outcomes, and Risk Factors
    • Authors: Chang Hwan Sohn; Jin Won Huh; Dong Woo Seo; Bum Jin Oh; Kyoung Soo Lim; Won Young Kim
      Abstract: Publication date: Available online 9 August 2017
      Source:The American Journal of Medicine
      Author(s): Chang Hwan Sohn, Jin Won Huh, Dong Woo Seo, Bum Jin Oh, Kyoung Soo Lim, Won Young Kim
      Background Aspiration pneumonia is associated with significant morbidity and mortality, however little is known about in patients with carbon monoxide intoxication which is the leading cause of poisoning-related death. This study aimed to evaluate the prevalence, clinical impacts and risk factors for developing aspiration pneumonia in carbon monoxide poisoning patients with loss of consciousness. Methods A retrospective analysis of a carbon monoxide poisoning registry was performed at our emergency department from January, 2008 to December, 2015. All adult carbon monoxide poisoning patients with loss of consciousness were included. Results Aspiration pneumonia developed in 103 (19.2%) of 537 patients. It was associated with increased ventilator use (52.4 vs. 3.2%), length of hospital stay (3.6 (2.1-5.1) vs. 1.3 (0.6-2.1) days), and in-hospital mortality (5.8 vs. 0.0%) (all, P < .001). Altered mental status on emergency department arrival, white blood cells, and increased exposure duration were the independent factors associated with development of aspiration pneumonia; odds ratios were 9.46 (95% CI, 4.92-18.19; P < .001), 1.19 (95% CI, 1.13-1.26; P < .001), and 1.12 (95% CI, 1.06-1.19; P < .001), respectively. For painful or unresponsive mental status and white blood cells > 12,000/mm3, odds ratio was increased up to 17.75 (95% CI, 10.65-29.59; P < .001). Conclusions The prevalence of aspiration pneumonia was 19.2% in carbon monoxide poisoning patients with loss of consciousness and was associated with poor outcomes. Also, altered mental status on emergency department arrival, white blood cells, and increased exposure duration were independently associated with the development of aspiration pneumonia.

      PubDate: 2017-08-16T13:06:07Z
      DOI: 10.1016/j.amjmed.2017.06.038
       
  • Low Albumin Levels are Associated with Mortality Risk in Hospitalized
           Patients
    • Authors: Amit Akirov; Hiba Masri Iraqi; Alaa Atamna; Ilan Shimon
      Abstract: Publication date: Available online 9 August 2017
      Source:The American Journal of Medicine
      Author(s): Amit Akirov, Hiba Masri Iraqi, Alaa Atamna, Ilan Shimon
      Aims Investigate the association of albumin levels on admission and change in levels during hospitalization with hospitalization outcomes. Methods Historical prospective data of patients hospitalized between 2011 and 2013. Levels of albumin were classified to marked hypoalbuminemia (<2.5 mg/dL), mild hypoalbuminemia (2.5-3.5 mg/dL), normal albumin (3.5-4.5 mg/dL) and hyperalbuminemia (>4.5 mg/dL). Main outcomes were length of hospitalization, in-hospital and long-term mortality. Results The cohort included 30,732 patients (mean age 67±18 years, 51% male). Most patients had normal albumin levels on admission (n=20,124, 65%), 29% of patients had hypoalbuminemia, mostly mild (n=7,334, 24%), and 5% of patients had marked hypoalbuminemia (n=1,436). Hyperalbuminemia on admission was evident in 6% of the patients (n=1,838). Follow-up (median±SD) was 1, 675±325 days. Compared to in-hospital mortality with normal albumin on admission (2%), mortality was higher with mild (12%) and marked hypoalbuminemia (34%) and lower with hyperalbuminemia (0.3%). Mortality rate at the end-of-follow-up was 29% with normal albumin levels, 67% and 83% with mild and marked hypoalbuminemia, respectively. Patients with hyperalbuminemia on admission and before discharge have the best short- and long-term survival. This pattern was similar when analyzed separately in different age groups. In patients with hypoalbuminemia on admission, normalization of albumin levels before discharge was associated with better short- and long-term survival, compared to patients with hypoalbuminemia before discharge. Conclusions Low albumin levels on admission are associated with increased short- and long-term mortality. Normalization of albumin levels before discharge was associated with lower mortality risk, compared to hypoalbuminemia before discharge.

      PubDate: 2017-08-16T13:06:07Z
      DOI: 10.1016/j.amjmed.2017.07.020
       
  • The Effect of Age on the Manifestations and Outcomes of Invasive
           Pneumococcal Disease in Adults
    • Authors: Thomas J. Marrie; Gregory J. Tyrrell; Sumit R. Majumdar; Dean T. Eurich
      Abstract: Publication date: Available online 9 August 2017
      Source:The American Journal of Medicine
      Author(s): Thomas J. Marrie, Gregory J. Tyrrell, Sumit R. Majumdar, Dean T. Eurich
      Background While a considerable amount is known about the effect of age on the manifestations and outcomes of pneumonia, the same is not true for invasive pneumococcal disease . Methods This was a prospective, observational study of all cases (2435) of invasive pneumococcal disease in adults in Northern Alberta from 2000 to 2014. Rates of invasive pneumococcal disease/100,000, sociodemographic variables, clinical characteristics, and invasive pneumococcal disease -related outcomes were compared for the following age groups – 17 to 54, 55 -64, 65 to 74 and 75 years and over. Results The rate of invasive pneumococcal disease /100,000 increased with increasing age. While only 27.3% of the cases were in those 65 years of age and over, they accounted for 48% of the deaths. The case fatality rate increased with increasing age from 9.6% for those 17-54 years of age to 31.7% for those 75 years of age and older. The rate of meningitis decreased with increasing age as did admission to intensive care and use of mechanical ventilation. There was a marked reduction in the rate of invasive pneumococcal disease due to protein conjugate vaccine 7 and protein conjugate vaccine 13 serotypes in those 55 years of age and over but a much smaller decline in those rates for those 17-54 years of age. Replacement with non vaccine serotypes constituted approximately 50% of the cases. Conclusions The rate of invasive pneumococcal disease is highest in the very elderly and manifestations of IPD are influenced by age.

      PubDate: 2017-08-16T13:06:07Z
      DOI: 10.1016/j.amjmed.2017.06.039
       
  • Temporal Trends in the Clinical Acuity of Patients with ST-Segment
           Elevation Myocardial Infarction.
    • Authors: Udhay Krishnan; Josef A. Brejt; Joshua Schulman-Marcus; Rajesh V. Swaminathan; Dmitriy N. Feldman; Parag Goyal; S. Chiu Wong; Robert M. Minutello; Geoffrey Bergman; Harsimran Singh; Luke K. Kim
      Abstract: Publication date: Available online 8 August 2017
      Source:The American Journal of Medicine
      Author(s): Udhay Krishnan, Josef A. Brejt, Joshua Schulman-Marcus, Rajesh V. Swaminathan, Dmitriy N. Feldman, Parag Goyal, S. Chiu Wong, Robert M. Minutello, Geoffrey Bergman, Harsimran Singh, Luke K. Kim
      Background Despite advances in ST-elevation myocardial infarction (STEMI) systems of care over the last decade, studies have shown no improvement in risk-adjusted mortality. It has been hypothesized that the population presenting to the catheterization lab has become sicker over time, in ways not accurately captured by current mortality models. Objective The objective of this study was to examine changes in the clinical characteristics and in-hospital case fatality rate of the STEMI population treated with early percutaneous coronary intervention (PCI). Methods We conducted a retrospective analysis of a nationwide inpatient database from 2004-2012. All patients with a diagnosis of STEMI who underwent PCI within 24 hours of admission were identified. The primary outcome was in-hospital mortality. Results From 2004-2012, there was a consistent increase in unadjusted in-hospital mortality (3.9% in 2004 and 4.7% in 2012, ORyear 1.03; 95% confidence interval [CI]:1.01-1.04). During this time, there was an increase in the proportion of patients with ≥ 3 Elixhauser comorbidities (14.8% vs. 29.0%, ptrend< .001). Intubation or cardiac arrest on presentation increased from 3.2% to 7.8%, (ptrend<.001) and had a strong, independent association with mortality. After multivariable adjustment using a model that incorporated the increasing trend in intubation/cardiac arrest, mortality decreased over time. (ORyear 0.95; 95% CI:0.94-0.97). Conclusions During a period that corresponds to improvement in STEMI quality of care, risk-adjusted in-hospital mortality declined. An increase in comorbidities, and more importantly, in the proportion of patients presenting with extreme-risk features may explain the overall “null” effect regarding in-hospital mortality despite improvements in timely reperfusion.

      PubDate: 2017-08-16T13:06:07Z
      DOI: 10.1016/j.amjmed.2017.06.040
       
  • Decreasing Clostridium Difficile-Associated Fatality Rates among
           Hospitalized Patients in the Unites States: 2004-2014
    • Authors: Manish P. Shrestha; Christian Bime; Sasha Taleban
      Abstract: Publication date: Available online 8 August 2017
      Source:The American Journal of Medicine
      Author(s): Manish P. Shrestha, Christian Bime, Sasha Taleban
      Background Clostridium difficile infection has emerged as a major public health problem in the United States over the last two decades. Several strategies have been implemented at the hospital, community, state and national levels to combat this infection. We examined the trends in the Clostridium difficile-associated fatality rate, hospital length of stay and hospital charges over the last decade. Methods We used data from the National Inpatient Sample to identify patients with a principal diagnosis of Clostridium difficile infection from 2004-2014. Outcomes included in-hospital fatality rate, hospital length of stay and hospital charges. For each outcome, trends were also stratified by age categories as the risk of infection and associated mortality increase with age. Results Clostridium difficile infection discharges increased from 19.9/100,000 persons in 2004 to 33.8/100,000 persons in 2014. Clostridium difficile-associated fatality decreased from 3.6% in 2004 to 1.6% in 2014 (linear trend P<0.001). Among patients aged 45-64 years, fatality decreased from 1.2% in 2004 to 0.7% in 2014 (linear trend P<0.001). Among patients aged 65-84 years, fatality decreased from 4.3% in 2004 to 2.0% in 2014 (linear trend P<0.001). Among patients aged ≥85 years, fatality decreased from 6.9% in 2004 to 3.6% in 2014 (linear trend P<0.001). The mean length of hospital stay decreased from 6.9 days in 2004 to 5.8 days in 2014 (P<0.001). The mean hospital charges increased from 2004 ($24,535) to 2014 ($35,898) (P<0.001). Similar trends were found across all age categories. Conclusion In-hospital fatality associated with Clostridium difficile infection in the United States has decreased over two fold in the last decade despite increasing infection rates. Despite decreasing length of stay, the hospital charges of Clostridium difficile infection are increasing.

      PubDate: 2017-08-16T13:06:07Z
      DOI: 10.1016/j.amjmed.2017.07.022
       
  • Making Cardiovascular Care More Responsive to Societal Needs
    • Authors: William S. Weintraub; William E. Boden
      Abstract: Publication date: Available online 7 August 2017
      Source:The American Journal of Medicine
      Author(s): William S. Weintraub, William E. Boden


      PubDate: 2017-08-16T13:06:07Z
      DOI: 10.1016/j.amjmed.2017.07.018
       
  • Advance Directives in Hospice Healthcare Providers: a Clinical Challenge
    • Authors: George R Luck; Terry Eggenberger; David Newman; Jacqueline Cortizo; Derek C Blankenship; Charles H. Hennekens
      Abstract: Publication date: Available online 7 August 2017
      Source:The American Journal of Medicine
      Author(s): George R Luck, Terry Eggenberger, David Newman, Jacqueline Cortizo, Derek C Blankenship, Charles H. Hennekens
      Background On a daily basis, healthcare providers, especially those dealing with terminally ill patients, such as hospice workers, witness how advance directives help ensure the wishes of patients. They also witness the deleterious consequences when patients fail to document the care they desire at their end of life. To the best of our knowledge there are no data concerning the prevalence of advance directives among hospice healthcare providers. We, therefore, explored the prevalence and factors influencing completion rates in a survey of hospice healthcare providers. Methods Surveys which included 32 items to explore completion rates as well as barriers, knowledge, and demographics were emailed to 2,097 healthcare providers, including employees and volunteers, at a nonprofit hospice. Results Of 890 respondents, 44% reported having completed an advance directive. Ethnicity, age, relationship status, and perceived knowledge were all significant factors influencing the completion rates while years of experience or working directly with patients had no effect. Procrastination, fear of the subject, and costs were common reasons reported as barriers. Upon completion of the survey, 43% said they will now complete an advance directive and 45% will talk to parents and families about their wishes. Conclusion The majority of hospice healthcare providers have not completed an advance directive. These results are very similar to those for other healthcare providers treating patients with terminal diseases, specifically oncologists. Since, at completion, 43% said that they would now complete an advance directive, such a survey of healthcare providers may help increase completion rates.

      PubDate: 2017-08-16T13:06:07Z
      DOI: 10.1016/j.amjmed.2017.07.019
       
  • Spinal Epidural Abscess: a Series of 101 Cases
    • Authors: Martin Vakili; Nancy F. Crum-Cianflone
      Abstract: Publication date: Available online 7 August 2017
      Source:The American Journal of Medicine
      Author(s): Martin Vakili, Nancy F. Crum-Cianflone
      Background Spinal epidural abscesses are uncommon but potentially devastating infections that often elude early diagnosis. An increasing incidence has been suggested; however, few contemporary data are available regarding risk factors and epidemiologic trends over time. Methods A retrospective study of spinal epidural abscesses from 2004 to 2014 at a large academic hospital was conducted. Cases were identified using ICD-9 code 324.1, and a review of medical and radiographic records was performed to confirm each case. Data collected included sociodemographics, medical history, suspected route of infection, treatments, and outcome. Results The incidence was 5.1 cases for each 10,000 admissions with no significant changes during the study period. The route of infection was identified in 52% of cases, with bacteremia as the most common (26%), followed by recent surgery/procedure (21%) and spinal injection (6%). An identifiable underlying risk factor was present in 84% of cases, most commonly diabetes and intravenous drug use. A causative organism was identified in 84% of cases, most commonly Staphylococcus aureus; methicillin-resistant isolates accounted for 25% of S. aureus cases. All cases received intravenous antibiotic therapy and 73% underwent a drainage procedure. Fifteen percent had an adverse outcome (8% paralysis and 7% death). Conclusions The incidence of spinal epidural abscesses may be increasing with the current study demonstrating a ≥5-fold higher rate compared with historical data. While the outcome in most cases was favorable, spinal epidural abscesses continue to cause substantial morbidity and mortality and should remain a “not to be missed diagnosis.”

      PubDate: 2017-08-16T13:06:07Z
      DOI: 10.1016/j.amjmed.2017.07.017
       
  • Subscription Information
    • Abstract: Publication date: August 2017
      Source:The American Journal of Medicine, Volume 130, Issue 8


      PubDate: 2017-08-16T13:06:07Z
       
 
 
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